Summary
A 49-year-old woman was diagnosed in 1985 as having pheochromocytoma because of hypertension
with high levels of plasma catecholamine concentration and 24-hour urine excretion
of vanillyl-mandelic acid and metanephrine together with a right adrenal mass. The
excised tumor cells had fine granular basophilic cytoplasm with argyrophilic granules
by Grimelius' method. Four years later, she was diagnosed as having a duodenal bulb
ulcer. Serum gastrin showed an abnormally high level of 1900 pg/ml. Abdominal echogram
and computed tomography revealed a hypoechoic lesion in the pancreas and intrahepatic
multiple tumors. A needle biopsy specimen of the liver tumor was compatible with the
histology of metastatic islet cell tumor. A diagnosis of Zollinger-Ellison syndrome
was made due to malignant gastrinoma with multiple liver metastases. The patient had
no family history of endocrinelogical or neoplastic disorders. The present case indicates
the possibility that pheochromocytoma and gastrinoma, that is, endocrine tumors characteristic
of multiple endocrine neoplasia (MEN) I and MEN II, may be coincident even in a person
without MEN. A continued awareness of previously rare or undescribed manifestations
is important in patients with islet cell tumors or pheochromocytoma.
Key words
Zollinger-Ellison Syndrome - Pheochromocytosma - Gastrinoma - Multiple Endocrine Neoplasia
